The treatment of mature permanent teeth with irreversible pulpitis by cervical pulpotomy: A systematic review.

Pulpotomy has been used in primary teeth and immature permanent teeth. However, with the advent of new bioactive material, the procedure is shifting towards permanent teeth with mature apices of roots. The objective of this systematic review was to evaluate the success of pulpotomy on mature permanent teeth with acute irreversible pulpitis and to compare it with root canal treatment or between the effectiveness of the bioactive material used. The following databases were searched: PubMed, Cochrane Library: Cochrane Central Register of Controlled Trials, Embase, ClinicalTrials.gov, International Clinical Trials Registry Platform. After using the keywords predefined, the electronic search yielded a total of 86 articles. After undergoing a thorough screening and eligibility process, only four articles were finally selected. Unexpectedly, pulpotomy demonstrated a better tendency for success in such cases over the years. This shows that pulpotomy is not inferior to root canal treatment for permanent treatment of irreversible pulpitis. In addition, the results obtained showed that pulpotomy is rapid, biologically reliable and more cost-effective in all situations compared to root canal therapy. Complete pulpotomy appears to have a high success rate as a permanent treatment of irreversible pulpitis and could be considered as an alternative to root canal therapy. Pulpotomy is not inferior to root canal treatment for a permanent treatment of irreversible pulpitis. In addition, the results obtained have shown that complete pulpotomy is faster and more profitable in all situations compared to root canal treatment. Furthermore, with the advent of new so-called bioactive materials, the use of this therapeutic is increasingly considered. This is why a review based on studies of reliable articles is above all necessary to be able to generalise the indication of this therapy.

Physicochemical and Mechanical Properties of Premixed Calcium Silicate and Resin Sealers.

The aim of the present in vitro study was to evaluate specific mechanical and physicochemical properties of two calcium silicate based sealers, (AH Plus Bioceramic "AHPB"; Well-Root ST "WRST"), and a conventional resin sealer (AH Plus "AHP"). These aims were accomplished by assessing the porosity, pH, compression strength, roughness, wettability and cell attachment of the tested materials. The results were compared statistically using the one-way ANOVA test. Higher pH values were obtained in both AHPB and WRST compared to AHP at 3, 24 and 72 h (p < 0.05). A greater level of porosity and wettability was detected for both AHPB and WRST compared to the resin sealer AHP (p < 0.05). Evident cell growth characterized by elongated morphology was observed on the surface of AHPB and WRST, while only a thin layer of cells was seen on the surface of AHP. A significant lower compression strength and modulus were obtained in the specimens created using AHPB compared to those made with AHP and WRST (p < 0.05). The removal of calcium silicates may be quite tricky during endodontic retreatment. In conclusion, considering the limitations of the present in vitro study, both calcium silicate sealers demonstrated good physicochemical properties. However, the lower compression strength and modulus of AHPB may facilitate its removal and make the retreatment procedures considerably easier.

Evaluation of the mono instrument (Wave One) mechanical action on the bacterial load reduction: In vitro study of 32 permanent human teeth.

CONTEXT: Enterococcus faecalis is the most common bacteria found in infected root canals. AIM: The purpose of this study was to evaluate the effect of the mono instrument (wave-one®) on the reduction of E. faecalis in root canals. MATERIALS AND METHODS: Thirty-two human monoroot teeth were used. After sterilization by autoclave, the teeth were infected by E. faecalis and incubated for 24 h. Each tooth underwent sampling before and after the root canal shaping. After serial dilution, samples were incubated, and colony-forming units were counted. RESULTS: The mono instrument technique reduced infection by E. faecalis in root canals of 30 teeth. The mean bacterial load (log10) was 3.98 before treatment and 1.20 after treatment. The paired t-test showed a significant mean difference (log10) of the bacterial load before and after treatment (P < 0.0001). CONCLUSION: This study found that the mono instrument (Wave One®) significantly decreases bacterial load in root canals. However, the instrument alone is not enough to eradicate infections; thus, the use of a complementary antimicrobial is required.

Bonding effectiveness of self-etch adhesives to dentin after 24 h water storage.

PURPOSE: This study evaluated the immediate bonding effectiveness of five self-etch adhesive systems bonded to dentin. MATERIALS AND METHODS: The microtensile bond strength of five self-etch adhesives systems, including one two-step and four one-step self-etch adhesives to dentin, was measured. Human third molars had their superficial dentin surface exposed, after which a standardized smear layer was produced using a medium-grit diamond bur. The selected adhesives were applied according to their respective manufacturer's instructions for µTBS measurement after storage in water at 37°C for 24 h. RESULTS: The µTBS varied from 11.1 to 44.3 MPa; the highest bond strength was obtained with the two-step self-etch adhesive Clearfil SE Bond and the lowest with the one-step self-etch adhesive Adper Prompt L-Pop. Pretesting failures mainly occurring during sectioning with the slow-speed diamond saw were observed only with the one-step self-etch adhesive Adper Prompt L-Pop (4 out of 18). CONCLUSIONS: When bonded to dentin, the self-etch adhesives with simplified application procedures (one-step self-etch adhesives) still underperform as compared to the two-step self-etch adhesive Clearfil SE Bond.

A 42-Month Follow-Up of Double Root Fracture of a Lateral Mandibular Incisor.

This case report describes the treatment of a double root fracture of a lateral mandibular incisor and its follow- up over 3.5 years. The reason for the consultation was a tooth mobility following a fall that had occurred 2 days earlier. A test of pulp vitality for tooth 42 was positive. Periodontal probing at the level of the gingival sulcus confirmed the intactness of the epithelial attachment. Retro-alveolar radiographic examination revealed a double root fracture of tooth 42. A semi-rigid extra-coronal splinting was performed and a light grinding of the incisal edge of tooth 42 was then carried out in light of the dislocation of the coronal fragment, and the occlusion was checked with a strip of articulating paper. The outcomes at 6 months revealed that pulp vitality was still preserved, consolidation of the apical fracture had occurred, and the coronal root fracture was starting to heal. The 1-year, 2-year and 3-year follow ups revealed preserved pulp vitality, an absence of a fracture line in apical images, and no root resorption. This case report provides evidence for the preservation of vitality in the setting of a double root fracture.